Right Ventricular Injury Definition and Management in Veno-Venous Extracorporeal Membrane Oxygenation.

Ryota Sato, Marta Velia Antonini, Kollengode Ramanathan, Kiran Shekar, Marcus J Schultz, Prashant Nasa, Hakeem Yusuff, Vasileios Zochios, Matthieu Schmidt, Abhijit Duggal, Mary Pat Harnegie, Daisuke Hasegawa, Siddharth Pawan Dugar, Matthew Charlton

Journal: ASAIO journal (American Society for Artificial Internal Organs : 1992) 2025;71(6):482-491

PMID: 39787611

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Abstract

Right ventricular injury (RVI) in respiratory failure receiving veno-venous extracorporeal membrane oxygenation (VV ECMO) is associated with significant mortality. A scoping review is necessary to map the current literature and guide future research regarding the definition and management of RVI in patients receiving VV ECMO. We searched for relevant publications on RVI in patients receiving VV ECMO in Medline, EMBASE, and Web of Science. Of 1,868 citations screened, 30 studies reported on RVI (inclusive of right ventricular dilation, right ventricular dysfunction, and right ventricular failure) during VV ECMO. Twenty-three studies reported on the definition of RVI including echocardiographic indices of RV function and dimensions, whereas 13 studies reported on the management of RVI, including veno-pulmonary (VP) ECMO, veno-arterial (VA) ECMO, positive inotropic agents, pulmonary vasodilators, ultra-lung-protective ventilation (Ultra-LPV), and optimization of positive end-expiratory pressure (PEEP). The definitions of RVI in patients receiving VV ECMO used in the literature are heterogeneous. Despite the high incidence of RVI during VV ECMO support and its strong association with mortality, studies investigating therapeutic strategies for RVI are also lacking. To fill the existing knowledge gaps, a consensus on the definition of RVI and research investigating RV-targeted therapies during VV ECMO is urgently warranted.

Address: From the Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.; Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio.; Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, Hawaii.; University Hospitals of Leicester National Health Service Trust, Glenfield Hospital Extracorporeal Membrane Oxygenation Unit, Leicester, United Kingdom.; Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom.; Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York.; Intensive Care Unit, Bufalini Hospital, Azienda Unità Sanitaria Locale della Romagna, Cesena, Italy.; Department of Biomedical, Metabolic and Neural Sciences, University of Modena & Reggio Emilia, Modena, Italy.; Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.; Internal Medicine, College of Medicine and Health Sciences, Abu Dhabi, United Arab Emirates.; National University Hospital, Singapore, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.; Department of Intensive Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.; Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.; Department of Anaesthesiology, Critical Care and Pain Medicine, Medical University of Vienna, Vienna, Austria.; The Cleveland Clinic Floyd D. Loop Alumni Library, Cleveland Clinic, Cleveland, Ohio.; Adult Intensive Care Services, Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.; Queensland University of Technology, Brisbane, Queensland, Australia.; University of Queensland, Brisbane and Bond University, Gold Coast, Queensland, Australia.; Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, AP-HP, Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Paris, France.

DOI: 10.1097/MAT.0000000000002369

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MeSH Terms: Humans, Extracorporeal Membrane Oxygenation, Heart Ventricles, Respiratory Insufficiency, Ventricular Dysfunction, Right